Skip to main content
SpringerLink
Log in
Book cover

Toxoplasma gondii pp 209–222Cite as

AIDS-Associated Cerebral Toxoplasmosis: An Update on Diagnosis and Treatment

  • Chapter

Part of the book series: Current Topics in Microbiology and Immunology ((CT MICROBIOLOGY,volume 219))

Abstract

Toxoplasmic encephalitis (TE) is one of the major opportunistic infections of the central nervous system (CNS) and the most frequent cause of focal brain lesions (FBL) in patients with acquired immunodeficiency syndrome (AIDS) (Luft et al. 1993). CNS toxoplasmosis is rapidly progressive and fatal without treatment and has been reported to be the AIDS index diagnosis in 22%-51% of patients infected with human immunodeficiency virus (HIV) (Leport et al. 1988; Cohn et al. 1989; Dannemann et al. 1991; Zangerle et al. 1991; Porter and Sande 1992).

This is a preview of subscription content, log in via an institution.

Chapter
USD   29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD   39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD   54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Learn about institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  • Ammassari A, Scoppettuolo G, Murri R, et al (1995) Temporal trends of toxoplasmic encephalitis (TE) and primary central nervous system lymphoma (PCNSL) in a prospective study on brain focal lesions. Fifth European Conference on Clinical Aspects and Treatment of HIV Infection, 26–29 September 1995, Copenhagen, Denmark, abstract 442

    Google Scholar 

  • Anson JA, Glick RP, Reyes MR (1992) Diagnostic accuracy of AIDS-related CNS lesions. Surg Neurol 37:432–440

    Article  PubMed  CAS  Google Scholar 

  • Antinori A, Murri R, Tamburrini E, De Luca A, Ortona L (1992) Failure of low-dose dapsone-pyrimethamine in primary prophylaxis of Pneumocystis carinii pneumonia. Lancet 340:788

    Article  PubMed  CAS  Google Scholar 

  • Antinori A, Ammassari A, Murri R, Tumbarello M, Ortona L, Scerrati M, Roselli R, Cefaro GA (1993) Primary central nervous system lymphoma and brain biopsy in AIDS. Lancet 341: 1411–1412

    Article  PubMed  CAS  Google Scholar 

  • Antinori A, Murri R, Ammassari A, et al (1995) Aerosolized pentamidine, cotrimoxazole, and dapsone-pyrimethamine for primary prophylaxis of P. carinii pneumonia and toxoplasmic encephalitis. AIDS 12:1343–1350

    Article  Google Scholar 

  • Aurelius E, Johansson B, Skoldenberg B, Staland A, Forsgren M (1990) Rapid diagnosis of herpes simplex encephalitis by nested polymerase chain reaction of cerebrospinal fluid. Lancet 337: 189–192

    Article  Google Scholar 

  • Bacellar H, Munoz A, Miller EN, Cohen BA, Besley O, Seines OA, Becker JT, McArthur JC (1994) Temporal trends in the incidence of HIV-1-related neurologic diseases: multicenter AIDS cohort study, 1985–1992. Neurology 44: 1892–1900

    Article  PubMed  CAS  Google Scholar 

  • Baumgartner JE, Rachlin JR, Beckstead JH, Meeker TC, Levy RM, Wara WM, Rosenblum MC (1990) Primary central nervous system lymphomas: natural history and response to radiation therapy in 55 patients with acquired immunodeficiency syndrome. J Neurosurg 73:206–211

    Article  PubMed  CAS  Google Scholar 

  • Bretagne S, Costa JM, Fleury-Feith J, et al (1995) Quantitative competitive PCR with bronchoalveolar lavage fluid for diagnosis of toxoplasmosis in AIDS patients. J Clin Microbiol 33: 1662–1664

    PubMed  CAS  Google Scholar 

  • Burg JL, Grover CM, Pouletty P, Boothroyd JC (1989) Direct and sensitive detection of a pathogenic protozoan, Toxoplasma gondii, by polymerase chain reaction. J Clin Microbiol 27:1787–1792

    PubMed  CAS  Google Scholar 

  • Carr A, Tindall B, Penny R, Cooper DA (1992) Trimethoprim sulfamethoxazole appears more effective than aerosolized pentamidine as secondary prophylaxis against Pneumocystis carinii pneumonia in patients with AIDS. AIDS 6:165–171

    Article  PubMed  CAS  Google Scholar 

  • Centers for Disease Control (1993) 1993 revised classification system for HIV infection and expanded surveillance case definition for AIDS among adolescents and adults. MMWR 41(RR17):1–19 iaCenters for Disease Control (1995) USPHS/IDSA guidelines for the prevention of opportunistic infections in persons infected with human immunodeficiency virus: a summary. MMWR 44:1–34

    Google Scholar 

  • Chappell ET, Guthrie BL, Orenstein J (1992) The role of stereotactic biopsy in the management of HIV-related focal brain lesions. Neurosurgery 30:825–829

    Article  PubMed  CAS  Google Scholar 

  • Cimino C, Lipton R, Williams A, Feraru E, Harris C, Hirschfeld A (1991) The evaluation of patients with human immunodeficiency virus-related disorders and brain mass lesions. Arch Intern Med 151:1381–1384

    Article  PubMed  CAS  Google Scholar 

  • Cingolani A, De Luca A, Larocca LM et al (1995) EBV-DNA detection in cerebrospinal fluid for the in vivo diagnosis of AIDS-associated primary CNS lymphoma. Fifth European Conference on Clinical Aspects and Treatment of HIV Infection, 26–29 September 1995, Copenhagen, Denmark, abstract 339

    Google Scholar 

  • Cinque P, Brytting M, Vago L, Castagna A, Parravicini C, Zanchetta N, d’Arminio-Monforte A, Wahren B, Lazzarin A, Linde A (1993) Epstein-Barr virus DNA in cerebrospinal fluid from patients with AIDS-related primary lymphoma of the central nervous system. Lancet 342:398–402

    Article  PubMed  CAS  Google Scholar 

  • Cirillo S, Rosenblum ML (1991) Use of CT and MR imaging to distinguish intracranial lesions and to define the need for biopsy in AIDS patients. J Neurosurg 73:720–724

    Google Scholar 

  • Cohn JA, McKeeking A, Cohen W, Jacobs J, Holzman RS (1989) Evaluation of the policy of empiric treatment of suspected Toxoplasma encephalitis in patients with the acquired immunodeficiency syndrome. Am J Med 86:521–527

    Article  PubMed  CAS  Google Scholar 

  • Dannemann BR, Israelski OM, Leoung GS, McGraw T, Mills J, Remington JS (1991) Toxoplasma serology, parasitemia and antigenemia in patients at risk for toxoplasmic encephalitis. AIDS 5: 1363–1365

    Article  PubMed  CAS  Google Scholar 

  • de Gans J, Portegies P, Reiss P, Troost O, van Gool T, Lange JM (1992) Pyrimethamine alone as maintenance therapy for central nervous system toxoplasmosis in 38 patients with AIDS. J Acquir Immune Defic Syndr 5:137–142

    PubMed  Google Scholar 

  • De Luca A, Antinori A, Cingolani A, et al (1995) Evaluation of cerebrospinal fluid EBV-DNA and IL-10 as markers for in vivo diagnosis of AIDS-related primary central nervous system lymphoma. Br J Haematol 90:844–849

    Article  PubMed  Google Scholar 

  • DeWit S, Katlama C, Clumeck N, and the ENTA toxoplasmosis study group (1994) Tolerance of pyrimethamine-clindamycin and pyrimethamine-sulfadiazine during acute therapy of toxoplasmic encephalitis in AIDS patients in a randomized European multicentre study (ENTA 004). Fourth European Conference on Clinical Aspects and Treatment of HIV Infection. 16–18 March 1994. Milan. Italy. abstract P192

    Google Scholar 

  • Dupon M, Cazenave J, Pellegrin JL, Ragnaud JM, Cheyron A, Fischer I, Leng B, Lacut JY (1995) Detection of Toxoplasma gondii by PCR and tissue culture in cerebrospinal fluid and blood of human immunodeficiency virus-seropositive patients. J Clin Microbiol 33:2421–2426

    PubMed  CAS  Google Scholar 

  • Eggers C, Gross U, Klinker H, Schalke B, Stellbrink HJ, Kunze K (1995) Limited value of cerebrospinal fluid for direct detection of Toxoplasma gondii in toxoplasmic encephalitis associated with AIDS. J Neurol 242:644–649

    Article  PubMed  CAS  Google Scholar 

  • Forsyth PA, Yahalom J, DeAngelis LM (1994) Combined-modality therapy in the treatment of primary central nervous system lymphoma in AIDS. Neurology 44:1473–1479

    Article  PubMed  CAS  Google Scholar 

  • Girard PM, Landman R, Gaudebout C, Olivares R, Saimont AG, Jelazko P, Gaudebout C, Certain A, Boue F, Bouvet E, Lecompte T, Couland JP (1993) Dapsone-pyrimethamine compared with aerosolized pentamidine as primary prophylaxis against Pneumocystis carinii pneumonia and toxoplasmosis in HIV infection. N Engl J Med 328:1514–1520

    Article  PubMed  CAS  Google Scholar 

  • Grant IH, Gold JWM, Rosenblum M, Niedzwiecki A, Armstrong D (1990) Toxoplasma gondii serology in HIV-infected patients: the development of cerebral nervous system toxoplasmosis in AIDS. AIDS 4:519–521

    Article  PubMed  CAS  Google Scholar 

  • Grover CM, Thulliez P, Remington S, Boothroyd JC (1990) Rapid prenatal diagnosis of congenital toxoplasmosis from amniotic fluid by polymerase chain reaction. J Clin Microbiol 28:2297–2301

    PubMed  CAS  Google Scholar 

  • Hardy WD, Feinberg J, Finkelstein DM, Power ME, He W, Kaczka C, Frame PT, Holmes M, Waskin H, Fass RJ, et al (1992) A controlled trial of trimethoprim-sulfamethoxazole or aerosolized pentamidine for secondary prophylaxis of Pneumocystis carinii pneumonia in patients with the acquired immunodeficiency syndrome. N Engl J Med 327: 1842–1848

    Article  PubMed  CAS  Google Scholar 

  • Haverkos HW (1987) Assessment of therapy for toxoplasmic encephalitis. Am J Med 82:907–914

    Article  PubMed  CAS  Google Scholar 

  • Heald A, Flepp M, Chave J-P, Malinverni R, Ruttimann S, Gabriel V, Renold C, Sugar A, Hirschel B (1991) Treatment of cerebral toxoplasmosis protects against Pneumocystis carinii pneumonia in patients with AIDS. Ann Intern Med 115:760–763

    PubMed  CAS  Google Scholar 

  • Lacoangeli M, Roselli R, Antinori A, Ammassari A, Murri R, Pompucci A, Scerrati M (1994) Experience with brain biopsy in acquired immune deficiency syndrome-related focal lesions of the central nervous system. Br J Surg 81: 1508–1511

    Article  Google Scholar 

  • Israelski DM, Chmiel JS, Poggensee L, Phair JP, Remington JS (1993) Prevalence of Toxoplasma infection in a cohort of homosexual men at risk of AIDS and toxoplasmic encephalitis. J Acquir Immune Defic Syndr 6:414–418

    PubMed  CAS  Google Scholar 

  • Jacobson MA, Besch CL, Child C, Hafner R, Matts JP, Muth K, Wentworth DN, Neaton JD, Abrams D, Rimland D (1994) Primary prophylaxis with pyrimethamine for toxoplasmic encephalitis in patients with advanced human immunodeficiency virus disease: results of a randomized trial. J Infect Dis 169:384–394

    Article  PubMed  CAS  Google Scholar 

  • Katlama C, De Wit S, Guichard A, Van Pottelsberghe C, Van Glabeke M, Clumeck N. and the ENTA Toxoplamosis Study Group (1994) Efficacy of pyrimethamine-clindamycin (P-C) for the long term suppressive therapy of toxoplasmosis encephalitis (TE) in AIDS patients (ENTA 04 study). Fourth European Conference on Clinical Aspects and Treatment of HIV Infection. 16–18 March 1994. Milan. Italy. abstract 043

    Google Scholar 

  • Kovacs JA (1992) Efficacy of atovaquone in treatment of toxoplasmosis in patients with AIDS. Lancet 340:637–638

    Article  PubMed  CAS  Google Scholar 

  • Lebech M, Lebech AM, Nelsing S, Vuust C, Mathiesen L, Petersen E (1992) Detection of Toxoplasma gondii-DNA by polymerase chain reaction in cerebrospinal fluid from AIDS patients with cerebral toxoplasmosis. J Infect Dis 165:982–983

    Article  PubMed  CAS  Google Scholar 

  • Leport C, Raffi F, Matheron S, Katlama C, Regnier B, Saimot AG, Marche C, Vedrenne C, Vilde JL (1988) Treatment of central nervous system toxoplasmosis with pyrimethamine/sulfadiazine combination in 35 patients with the acquired immunodeficiency syndrome. Am J Med 84:94–100

    Article  PubMed  CAS  Google Scholar 

  • Leport C, Tournerie C, Raguin G, Fernandez-Martin J, Nijongabo T, Vilde JL (1991) Long-term follow-up of patients with AIDS on maintenance therapy for toxoplasmosis. Eur J Clin Microbiol Infect Dis 10: 191–193

    Article  PubMed  CAS  Google Scholar 

  • Levy RM, Russell E, Yungbluth M, Hidvegi DF, Brody BA, Dal-Canto MC (1992) The efficacy of image-guided stereotactic brain biopsy in neurologically symptomatic acquired immunodeficiency syndrome patients. Neurosurgery 30: 186–190

    Article  PubMed  CAS  Google Scholar 

  • Luft BJ, Remington JS (1988) Toxoplasmic encephalitis. J Infect Dis 157:1–6

    Article  PubMed  CAS  Google Scholar 

  • Luft BJ, Hafner R, Korzun AH, Leport C, Antoniskis D, Bosler EM, Bourland DD, Uttamchandani R, Fuhrer J, Jacobson J, et al (1993) Toxoplasmic encephalitis in patients with the acquired immunodeficiency syndrome. N Engl J Med 329:995–1000

    Article  PubMed  CAS  Google Scholar 

  • Morgello S, Petito CK, Mouradian JA (1990) Central nervous system lymphoma in the acquired immunodeficiency syndrome. Clin Neuropathol 9:205–215

    PubMed  CAS  Google Scholar 

  • Morlat P, Chene G, Leport C, Rousseau F, Luft B, Aubertin J, Hafner R, Salamon R, Vilde JL (1993) Prevention primaire de la toxoplasmose cerebrale chez le sujet infecte par le VIH: resultats d’un essai randomise en double insu, pyrimethamine versus placebo. Rev Med Interne 14:1002

    Article  PubMed  CAS  Google Scholar 

  • Mouthon B, Katlama C, Caumes E, Bricaire F, Gentilini M (1994) Atovaquone (ATO) as long-term suppressive therapy in toxoplasmosis. Fourth European Conference on Clinical aspects and Treatment of HIV Infection, 16–18 March 1994, Milan, Italy, abstract 043

    Google Scholar 

  • Navia BA, Petito CK, Gold JWM, Cho ES, Jordan BD, Price RW (1986) Cerebral toxoplasmosis complicating the acquired immune deficiency syndrome:clinical and neuropathological findings in 27 patients. Ann Neurol 19:224–238

    Article  PubMed  CAS  Google Scholar 

  • Novati R, Castagna A, Morsica G, Vago L, Tambussi G, Ghezzi S, Gervasoni C, Bisson C, d’Arminio-Monforte A, Lazzarin A (1994) Polymerase chain reaction for Toxoplasma gondii DNA in cerebrospinal fluid of AIDS patients with focal brain lesions. AIDS 8: 1691–1694

    Article  PubMed  CAS  Google Scholar 

  • Oksenhendler E, Charreau I, Tournerie C, Azihary M, Carbon C, Aboulker JP (1994) Toxoplasma gondii infection in advanced HIV infection. AIDS 8:483–487

    Article  PubMed  CAS  Google Scholar 

  • Opravil M, Heald A, Lazzarin A, Heald A, Ruttimann S, Iten A, Furrer H, Oertle D, Praz G, Vuitton DA et al (1995) Dapsone-pyrimethamine versus aerosolized pentamidine for combined prophylaxis of PCP and toxoplasmic encephalitis. Clin Infect Dis 20:531–541

    Article  PubMed  CAS  Google Scholar 

  • Pedrol E, Gonzalez-Clemente JM, Gatell JM, Mallolas J, Miro JM, Grans F, Alvarez R, Mercorder JM, Berenguer J, Jimenez de Anta MT et al (1990) Central nervous system toxoplasmosis in AIDS patients: efficacy of an intermittent maintenance therapy. AIDS 4:511–517

    Article  PubMed  CAS  Google Scholar 

  • Pell MF, Thomas DGT, Whittle IR (1991) Stereotactic biopsy of cerebral lesions in patients with AIDS. Br J Neurosurg 5:585–589

    Article  PubMed  CAS  Google Scholar 

  • Podzamczer D, Miro JM, Bolao F, et al (1995) Twice-weekly maintenance therapy with sulfadiazine-pyrimethamine to prevent recurrent toxoplasmic encephalitis in patients with AIDS. Ann Intern Med 123:175–180

    PubMed  CAS  Google Scholar 

  • Porter SB, Sande MA (1992) Toxoplasmosis of the central nervous system in the acquired immunodeficiency syndrome. N Engl J Med 327: 1643–1648

    Article  PubMed  CAS  Google Scholar 

  • Ruf B, Schurmann D, Bergmann F, Schuler-Maue W, Grunewald T, Gottschalk HJ, Witt H, Pohle HD (1993) Efficacy of pyrimethamine/sulfadoxine in the prevention of toxoplasmic encephalitis relapses and Pneumocystis carinii pneumonia in HIV-infected patients. Eur J Clin Microbiol Infect Dis 12:325–329

    Article  PubMed  CAS  Google Scholar 

  • Schoondermark-van de Yen E, Galama J, Kraaijeveld C, van Druten J, Meuwissen J, Melchers W (1993) Value of polymerase chain reaction for the detection of Toxoplasma gondii in cerebrospinal fluid from patients with AIDS. Clin Infect Dis 16:661–666

    Article  Google Scholar 

  • Steinmetz H, Arendt G, Hefter H, Neuen-Jacob E, Dorries K, Aulich A, Kahn T (1995) Focal brain lesions in patients with AIDS:aetiologies and corresponding radiological patterns in a prospective study. J Neurol 242:69–74

    Article  PubMed  CAS  Google Scholar 

  • Tenant-Flowers M, Boyle MJ, Carey D, Marriott DJ, Harkness JL, Penny R, Cooper DA (1991) Sulfadiazine desensitization in patients with AIDS and cerebral toxoplasmosis. 5:311–315

    CAS  Google Scholar 

  • Torres R, Weinberg W, Stansell J, et al (1993) Multicenter clinical trial of atovaquone (ATO) for salvage treatment and suppression of toxoplasmic encephalitis (TE). Ninth International Conference on AIDS, 6–11 June 1993, Berlin, Germany, abstract PO-B10-1453

    Google Scholar 

  • Wallace MR, Rossetti RJ, Olson PE (1993) Cats and toxoplasmosis risk in HIV-infected adults. JAMA 269:76–77

    Article  PubMed  CAS  Google Scholar 

  • Weiss LM, Udem SA, Salgo M, Tanowitz HB, Wittner M (1991) Sensitive and specific detection of Toxoplasma DNA in an experimental murine model: use of T.gondii-specific cDNA and the polymerase chain reaction. J Infect Dis 193:180–186

    Article  Google Scholar 

  • Zangerle R, Allerberger F, Pohl P, Fritsch P, Dierich MP (1991) High risk of developing toxoplasmic encephalitis in AIDS patients seropositive to Toxoplasma gondii. Med Microbiol Immunol 180:59–66

    Article  PubMed  CAS  Google Scholar 

  • Zimmer C, Marzheuser S, Patt S (1992) Stereotactic brain biopsy in AIDS. J Neurol 239:394–400

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Infectious Diseases, Catholic University, L.go A. Gemelli 8, 00168, Rome, Italy

    A. Ammassari, R. Murri, A. Cingolani, A. De Luca & A. Antinori

Authors
  1. A. Ammassari
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. R. Murri
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Cingolani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. De Luca
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Antinori
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute for Hygiene and Microbiology, University of Würzburg, Josef-Schneider-Str. 2, D-97080, Würzburg, Germany

    Uwe Gross

Rights and permissions

Reprints and permissions

Copyright information

© 1996 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Ammassari, A., Murri, R., Cingolani, A., De Luca, A., Antinori, A. (1996). AIDS-Associated Cerebral Toxoplasmosis: An Update on Diagnosis and Treatment. In: Gross, U. (eds) Toxoplasma gondii. Current Topics in Microbiology and Immunology, vol 219. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-51014-4_19

Download citation

  • DOI: https://doi.org/10.1007/978-3-642-51014-4_19

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-642-51016-8

  • Online ISBN: 978-3-642-51014-4

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation